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PT624 Neuro > Exam 2 pt 2 > Flashcards

Exam 2 pt 2 Flashcards

1
Q

Deadliest of all head injuries

A

Epidural hematoma

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2
Q

Epidural hematoma

A

Arterial bleeding that fills cranial cavity very quickly, compressing brain tissue (High pressure bleed)

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3
Q

Epidural hematoma often results in

A

brain injury and may lead to death (medical emergency)

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4
Q

Subdural hematoma occurs

A

following rupture of vessel–usually vein–between brain and dura (low pressure bleed)

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5
Q

3 types of subdural hematoma

A

Acute, subacute, and chronic

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6
Q

Most dangerous type of subdural hematoma

A

Acute

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7
Q

Time it takes for S&S of acute subdural hematoma to occur

A

Usually immediately

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8
Q

Time it takes for S&S of subacute subdural hematoma to occur

A

Days to weeks

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9
Q

Time it takes for S&S of chronic subdural hematoma to occur

A

Can take weeks

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10
Q

Subarachnoid/intraparenchymal hemorrhage is a result of

A

blood pooling inside brain

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11
Q

If subarachnoid/intraparenchymal hemorrhage is caused by trauma, it is usually accompanied by

A

DAI

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12
Q

Nontraumatic causes of subarachnoid/intraparenchymal hemorrhage

A

AVM
Chronic HTN
Brain tumors
Blood thinners

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13
Q

Subfalcal herniation

A

Herniation of the cingulate gyrus under the falx cerebri toward the opposite hemisphere

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14
Q

Uncal herniation

A

Herniation of part of the medial temporal lobe through the tentorial notch and is pressing the midbrain against the tentorium

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15
Q

Herniation causing decorticate posturing

A

Uncal herniation

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16
Q

Herniation causing decerebrate posturing

A

Tonsilar herniation

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17
Q

Decorticate posturing is due to

A

a lesion at the level of the midbrain separating the forebrain from the brainstem

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18
Q

Tonsilar herniation

A

One tonsil of the cerebellum herniates through the foramen magnum, compressing the medulla against the margin of the foramen

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19
Q

Decerebrate posturing is due to

A

lesion at the level of the lower brain stem separating the brain from the spinal cord

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20
Q

Normal ICP

A

5-10 mmHg

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21
Q

Etiology of stroke

A

Ischemic 80%

Hemorrhage 20%

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22
Q

Etiology of TBI

A

MVA

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23
Q

Signs and symptoms of stroke

A

Hemiplegia, unilateral, focal, neurologic

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24
Q

Signs and symptoms of TBI

A

Bilateral, focal, diffuse

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25
Q

Age in those with stroke

A

Old

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26
Q

Age in those with TBI

A

Young

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27
Q

Cost of severe stroke

A

$250,000

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28
Q

Cost of severe TBI

A

$4 mil

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29
Q

Recovery period for stroke

A

3-6 months

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30
Q

Recovery period for TBI

A

Years

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31
Q

Recovery pattern for stroke

A

Hypo- to hypertonicity

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32
Q

Recovery pattern for TBI

A

Rancho LOCF

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33
Q

Risk factors for stroke

A

Medical

34
Q

Risk factors for TBI

A

Personality/lifestyle

35
Q

Long term impairments/disability for stroke

A

Sensorimotor, cognitive

36
Q

Long term impairments/disability for TBI

A

Cognitive, behavioral

37
Q

Functional limitations for stroke

A

B/I ADL

38
Q

Functional limitations for TBI

A

IADL

39
Q

Permanent disability for stroke

A

70%

40
Q

Permanent disability for TBI

A

90%

41
Q

Reoccurrence for stroke

A

Low/medium 10%

42
Q

Reoccurrence for TBI

A

High

43
Q

Ability to predict outcome for stroke

A

Fair/good

44
Q

Ability to predict outcome for TBI

A

Poor

45
Q

Cerebral perfusion pressure

A

MAP-ICP

46
Q

Normal CPP

A

70-100 mmHg

47
Q

Do not treat if ICP is

A

Greater than 20-25

48
Q

Medications used for increased ICP

A

Edema control
Anticonvulsants: seizure prophylaxis
Neuromuscular blockade/sedation

49
Q

Types of meds for edema control (Increased ICP)

A

Osmotic diuretics
Steroids
Barbiturates (CNS depressant)

50
Q

Other meds used for BI

A

Meds for agitation, seizures, and spasticity

51
Q

Early signs of increased ICP: Consciousness

A

Confusion
Lethargy
Weakness
Restlessness

52
Q

Early sign of increased ICP: Pupil

A

Sluggish

53
Q

Early signs of increased ICP:Vision

A

Blurred/diplopia/decreased acuity, papilledema

54
Q

Early signs of increased ICP: Motor

A

Contralateral paresis

55
Q

Early signs of increased ICP: Vital signs

A

Stable

56
Q

Early signs of increased ICP: Additional findings

A

Headache, nausea, seizures, CN palsy

57
Q

Late signs of increased ICP: Consciousness

A

Coma

58
Q

Late signs of increased ICP: Pupil

A

Fixed/dilated

59
Q

Late signs of increased ICP: Motor

A

Abnormal posturing

Flaccid if herniation

60
Q

Late signs of increased ICP: Vital signs

A

Acute increase in ICP causes compression of the cerebral blood vessels
Leads to cerebral ischemia
Leads to increase systemic blood pressure over the vasomotor center with simultaneous decrease in HR/RR (Cushing’s response)

61
Q

Late signs of increased ICP: Additional findings

A

Headache
Vomiting
Changes in brain stem reflexes

62
Q

3 types of cerebral edema

A

Vasogenic
cytotoxic
interstitial

63
Q

Clinically most important type of cerebral edema

A

Vasogenic

64
Q

How does vasogenic edema happen

A

Damage to BBB
Leads to inflammation
Leads to increase in permeability

65
Q

How does vasogenic edema spread

A

Starts in area of injury and spreads and damages ipsilateral white matter

66
Q

Focal neurologic deficits of vasogenic edema

A

Decrease in consciousness

67
Q

How does vasogenic edema resolve

A

By slow diffusion

68
Q

How does cytotoxic edema happen

A

Disruption of cellular metabolism
BBB is intact
Leakage of proteins and fluid from damaged blood vessels (grey matter)

69
Q

What is interstitial edema

A

Rare non-communicating hydrocephalus

70
Q

Breathing types

A

Cheyne-Stokes
Kussmal
Apneustic

71
Q

Cheyne-Stokes

A

Periods of apnea followed by periods of hyperpnea

72
Q

Kussmaul

A

Rhythmic, gasping, deep respiration associated with severe acidosis or coma

73
Q

Apneustic

A

Prolonged slow inspirations, short expiratory phase

74
Q

Cause of respiratory changes

A

Damage to respiratory centers (pons or upper medulla)

Removal of input from vagus nerve and pneumotaxic center in pons

75
Q

Ventilator modes from most severe to least severe

A

Assist control
Synchronized intermittent mandatory ventilation
Continuous positive airway pressure (CPAP)

76
Q

Assist control mode

A

Breathes for patient (ventilator overrides pt effort)

77
Q

Synchronized intermittent mandatory ventilation mode

A

Breathes with patient (patient overrides ventilator)

78
Q

Continuous positive airway pressure (CPAP) mode

A

Maintains open airway (patient must breathe on own)

79
Q

PT role in ICU

A

Perform PT initial eval
Gain and maintain a clear chest
Prevent skin breakdown
Prevent loss of ROM
Stimulate consciousness
Sits at bedside/co-treat, even if patient is comatose or in persistent vegetative state
Part of team involved in family education

80
Q

Minimally conscious state characteristics

A 
Following simple commands
Gestural yes/no responses
Intelligible verbalizations
Purposeful, non reflexive behavior
Imaging: activation of appropriate CNS centers
81
Q

Brain dead characteristics

A 
No brain stem reflexes
No response to pain
No spontaneous respiration
Flat EEG (not required)
Usually confirmed by 2 independent physicians
Organ donation possible
82
Q

Persistent vegetative state characteristics

A 
"disorder of consciousness"
After 4 weeks of vegetative stage
Brain stem function relatively intact
Usually no ventilation
Some response to simulation

PT624 Neuro (13 decks)

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